Obamacare’s rollout has become a punch line for late-night comedians, Saturday Night Live, and the Country Music Awards, which all noted that only six people enrolled in the federal health exchange’s website on its first day.

But the federal exchange isn’t the only part of the health law that’s suffering. Several states and the District of Columbia don’t even break double digits within the first month. Some examples:

  • Delaware is off to a slow start with only four state residents enrolling in Obamacare health plans. Four community groups in the state received $4 million in federal tax money to promote the exchange.
  • North Carolina has managed to get one enrollee, but officials admit that the person has not paid—suggesting a “payment re-direct option” on the government servers isn’t working. The state is also confronting a “scammer,” who was trying to obtain personal information using an insurer’s name.
  • Oregon has yet to enroll anyone on its exchange website, which still doesn’t work. The state hired 400 temporary workers to process paper applications.
  • The District of Columbia enrolled only five people in its insurance exchange.

Even Maryland’s health exchange, considered a model for state exchanges, has had a slow and troubled start. One example is Maryland resident Brian Shaffer, one of millions of Americans who lost his current coverage because it didn’t comply with Obamacare. He was denied several times from buying new insurance on the state exchange because the state wouldn’t verify his citizenship.

According to WJLA ABC7, Shaffer—who has researched his U.S. family history back to the Mayflower—faxed his driver’s license and birth certificate twice but the state said it needed more proof.

“I believe it’s just sheer stupidity,” he told WJLA.

Covered California, the enrollment exchange for California and another early adopter of Obamacare, also has reported a faulty provider directory, continuing delays with agent certification, delays with final plan approval, and software bugs, according to LifeHealthPro.

Another little-reported issue for states is the soaring enrollment of new Medicaid enrollees, which will drive up costs to state budgets. Stateline reports that Medicaid enrollment in October was far higher than private insurance in the exchanges.

If that trend continues, many Americans could find themselves in a low-quality, low-access program that substantially increases the overall cost of Obamacare for taxpayers.